[MRI of fingers in systemic scleroderma. Initial results with contrast-enhanced studies using a dedicated MRI system].
OBJECTIVE
To estimate disease activity in patients with systemic sclerosis using contrast-enhanced MRI of the skin.


METHODS
In a pre-study, sequences of a low-field (0.2 T) scanner (Artoscan, Esaote, Genova, Italy) were optimized for detection of intravenous contrast (0.1 mmol/l Gd-DTPA) in six patients with the autoimmune disease systemic scleroderma. Based on the results of the pre-study, 17 patients with scleroderma (7 sclerotic/10 active inflammatory disease) were scanned using gradient-spoiled 3D GRE sequences (FA 90 degrees, TR 100 ms, TE 18 ms), which had been established as most sensitive for intravenous contrast. Contrast enhancement of the skin was determined quantitatively by contrast-to-noise ratios (CNR), comparing post- to pre-contrast and dynamic scans (for 6 min, 1 acquisition/min). Patients in the chronic state with sclerodactylia and active inflammation of the hands were considered separately and compared to a control group (n = 10) matched according to age.


RESULTS
CNR increase after intravenous contrast was significantly higher in patients with active disease (86 +/- 16% increase) than sclerosing disease (29 +/- 3%, p < 0.05) and the control group (4 +/- 2%, p < 0.05). The dynamic examination showed a significantly slower decrease after the peak rise in the first minute in patients with active disease (CNR 15.4 +/- 0.7 to 14.2 +/- 1.4) than in those with chronic disease (14.1 +/- 0.5 to 11.3 +/- 0.9, p < 0.05).


CONCLUSIONS
Capillary leakage is the most likely explanation for the increased enhancement in patients with active scleroderma. Using sequences optimized for contrast detection, disease activity in the course of scleroderma and response to therapy can be determined by MRI in the future.
Bonél
H
H
Institut für Radiologische Diagnostik, Klinikum Grosshadern, Ludwig-Maximilians-Universität München.
Messer
G
G
Seemann
M
M
Walchner
M
M
Röcken
M
M
Reiser
M
M
D000328:Adult; D000368:Aged; D016477:Artifacts; D003287:Contrast Media; D004867:Equipment Design; D005260:Female; D005385:Fingers / Q000473:pathology*; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000175:diagnosis*; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA
MRT der Finger bei systemischer Sklerodermie. Erste Ergebnisse mit kontrastverstärkten Untersuchungen an einem dedizierten MRT-System.